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Integrated Approach in the Control of Neglected Tropical Diseases with Cutaneous Manifestations in Four Municipalities in Benin: a Cross-Sectional Study

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Integrated Approach in the Control of Neglected Tropical Diseases with Cutaneous Manifestations in Four Municipalities in Benin: a Cross-Sectional Study Vol. 13(3), pp. 184-191, July-September 2021 DOI: 10.5897/JPHE2021.1332 Article Number: D5518AA67362 ISSN: 2141-2316 Copyright©2021 Author(s) retain the copyright of this article Journal of Public Health and Epidemiology http://www.academicjournals.org/JPHE Full Length Research Paper Integrated approach in the control of neglected tropical diseases with cutaneous manifestations in four municipalities in Benin: A cross-sectional study Parfait DJOSSOU1*, Ghislain Emmanuel SOPOH2, Ronald Sètondji GNIMAVO2, Esaï Gimatal ANAGONOU3, Zoulkifl Salou BACHIROU1, Franck Zinsou Maurille MIGNANWANDE1, Horace DEGNONVI1, Flora Sylvie HOUNDJREBO4, Jean Gabin HOUEZO3, Akpéédjé Carolle WADAGNI3, Yves Thierry BAROGUI3 and Roch Christian JOHNSON1 1Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey-Calavi, Bénin. 2Institut Régional de Santé Publique-Comlan Alfred QUENUM, Ouidah, Université d’Abomey-Calavi, Bénin. 3Programme National de Lutte contre la Lèpre et l’Ulcère de Buruli, Ministère de la Santé, Bénin. 4Laboratoire d’Anthropologie Médicale Appliquée, Université d’Abomey-Calavi, Bénin. Received 24 May, 2021; Accepted 19 July, 2021 The integrated approach is the new recommendation of the World Health Organization (WHO) for the control of neglected tropical diseases. The goal of this cross-sectional study was to implement this approach in 4 municipalities with a high prevalence of leprosy in Benin from September 2019 to August 2020. Mobile medical consultations were organized in these municipalities following the mobilization and sensitization of the populations. In the 4 municipalities, 6416 people were examined. The mean age was (27.3 ±19.8) years. Women represented 52.7% of people examined. Among the 6416 people examined, 1230 (19.2%) had skin conditions. The most common skin conditions were pityriasis versicolor (421 cases; 34.2%); eczema (203 cases; 16.5%); ringworm (159 cases; 12.9%); pruritus sine materia (81 cases; 6.6%); acne (62 cases; 5.0%); epidermophytia (37 cases; 3.0%); achromic nevus (35 cases; 2.8%); keloids (28 cases; 2.3%); chronic ulcers (27 cases; 2.2%) and depigmentation stigmata (24 cases; 2.0%). 8 new leprosy cases (0.7%) were detected. This study proves the efficiency of the integrated approach in the control of neglected tropical diseases (NTDs) with cutaneous manifestations in Benin. Key words: Neglected tropical disease, leprosy, skin disease, integration, disease control, Benin. INTRODUCTION The skin is the most visible structural element both for personal and social well-being of the patient. The skin is patients and caregivers who examine them. Any skin therefore an important point of intervention for both condition is noticeable and will have an effect on the diagnostic and therapeutic procedures (OMS, 2018a). *Corresponding author. E-mail: [email protected]. Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License Djossou et al. 185 Many neglected tropical diseases (NTDs) affect the municipalities of Djidja, Ouinhi, Zagnanado and Kétou. skin, causing considerable disability, stigma and exacerbation of poverty (Engelman et al., 2016). NTDs Participants cause changes in the skin, with symptoms ranging from pruritus to changes in colour, feeling or appearance A non-probabilistic method in conjunction with a convenience- (OMS, 2018a). In addition, NTDs with cutaneous based choice technique was used in this study. Thus, any person who was at least 1 year old, available and who gave consent after manifestations are co-endemic in many countries, districts being informed, was included in the study. For participants under 18 and communities (Amazigo, 2008; Alvar et al., 2012; van years old, the consent of parents or guardians has been requested. de Sande, 2013; Mitjà et al., 2014; WHO, 2014; Mitjà et al., 2015; Yotsu et al., 2015; WHO, 2016). These cutaneous NTDs are responsible for the loss of a large number of Data collection disability-adjusted life years (DALY) (WHO, 2010). Social mobilization was carried out in the 96 villages by community Integrating efforts to control cutaneous NTDs can health volunteers, local elected officials and town criers. Information facilitate progress in understanding and controlling this sessions on skin diseases, especially leprosy, were organized for diverse group of diseases (Engelman et al., 2016). the participants. Thus, the purpose and benefits of the study were Indeed, examination of the skin offers the opportunity to presented each time at the start of consultations in the villages where the study was conducted. The consultations were done in screen individuals in communities or children in schools public places, sometimes in schools, in rooms well-lit by daylight to identify multiple conditions in a single visit. This while respecting the patients’ privacy. Two teams were formed, common approach for controlling these skin diseases each composed a leprosy specialist/dermatologist, a local health justifies the integrated delivery of health care worker and a data collection agent. When a person, after being interventions to both increase cost-effectiveness and informed of the objectives of the study, agrees to participate, he/she expand coverage (Mitjà et al., 2017). is examined by a leprosy specialist/dermatologist. This latter looked for the cardinal signs of leprosy and for symptoms of Buruli ulcers In Benin, two programmes have been involved in the (BU) and yaws on the participant's body. In addition, the leprosy control of NTDs. The National Program for the Control of specialist/dermatologist looked for signs of other dermatoses (OMS, Neglected Tropical Diseases (PNLMTN) is engaged in 2018b). The leprosy specialists/dermatologists were helped by local the treatment of NTDs in general, whereas the National health workers and data collectors who were responsible for Program for the Control of Leprosy and Buruli Ulcers providing out dermatological drugs and filling out data collection (PNLLUB) addresses only cutaneous NTDs including forms. Thus, the sociodemographic information and data on the characteristics of the skin conditions were collected. Leprosy Buruli ulcers, leprosy and yaws. Despite the efforts of screening was carried out by leprosy specialists/dermatologists these programmes, NTDs in general and those with according to the WHO clinical criteria. The leprosy patients were cutaneous manifestations in particular persist. Many clinically diagnosed according to the WHO clinical definitions. The challenges remain for these programmes, especially patients were classified as paucibacillary (≤ 5 lesions) or PNLLUB, in achieving the control of Buruli ulcers and multibacillary (> 5 lesions or with nerve enlargement) according to the WHO classification (Géniaux, 2010; OMS, 2016). All leprosy yaws, the elimination of leprosy and the management new cases detected were systematically placed on multidrug and/or intensive care of the other cutaneous NTDs. The therapy (MDT). After receiving the first supervised dose of MDT, purpose of this study was to implement integrated these patients were referred to the municipality’s Leprosy Nursing approach for the control of NTDs with cutaneous Supervisor and the most accessible responsible health worker. manifestations in the municipalities of Djidja, Ouinhi, These patients benefited the disability prevention counselling Zagnanado and Kétou in Benin. sessions too. Some were given shea butter for the care of scars and the prevention of dry skin. The contacts of new leprosy cases were systematically examined too. In addition, the non-leprosy patients were carefully assessed by the leprosy specialists/ MATERIALS AND METHODS dermatologists to determine the type of dermatosis and the appropriate treatment. An appropriate treatment was given to each Study framework type of dermatosis diagnosed. The necessary inputs for bandages and dressings were also made available to patients with chronic The study was conducted in 96 villages of the municipalities of ulcers. These patients were then referred to the nearest BU Djidja, Ouinhi, Zagnanado (in the department of Zou) and Kétou (in treatment centres. the department of Plateau) in Benin (Figure 1). These municipalities were selected according to the endemicity of leprosy (PNLLUB, 2019). The estimated populations of these municipalities were Variables respectively 146,681, 70,507, 65,377 and 186,834 inhabitants for Djidja, Ouinhi, Zagnanado and Kétou (INSAE, 2016). The variable of interest was the skin condition diagnosed through the presence of clinical signs. The sociodemographic informations such as age and gender were recorded for each person examined. Study design and population Data processing and statistical analysis This is a cross-sectional study carried out from September 2019 to August 2020. It was conducted on the populations of the The data collected in the field were recorded using Microsoft Excel 186 J. Public Health Epidemiol. Figure 1. Municipalities and villages investigated in the study. 2016 and analysed with IBM SPSS 25. Proportions were calculated (159 cases; 12.9%); pruritus sine materia (81 cases; for the different skin conditions detected and for the other 6.6%); acne (62 cases; 5.0%); epidermophytia (37 cases; qualitative variable (gender). The mean and standard deviation 3.0%); achromic nevus (35 cases; 2.8%); keloids (28 were determined for the quantitative variable (age). cases; 2.3%); chronic ulcers (27
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